Early and late arrhythmias in patients in preoperative sinus rhythm submitted to mitral valve surgery through the superior septal approach.

Background: It has been hypothesized that the use of the superior septal approach to the mitral valve can lead to postoperative loss of sinus rhythm. This study was undertaken to evaluate the early and mid-term alterations of the cardiac rhythm in patients with preoperative sinus rhythm (SR) submitted to mitral valve surgery through the superior septal approach.

Methods: Seventy-five cases in preoperative SR submitted to primary isolated mitral valve surgery through the superior septal approach constitute the study population. All patients underwent 12-lead electrocardiography on admission, every day after surgery until discharge and every year during the follow-up period.

Results: On admission in the intensive care unit, 46 cases maintained their preoperative rhythm, whereas 18 developed a junctional rhythm (JR) and 7 had a first- or second-degree atrio-ventricular block (AVB). Four cases arrived in the unit in atrial fibrillation (AF). On the first postoperative day, these proportions were substantially unchanged, with the only exception being a slight increase in the number of patients in AF. The day before discharge, only 35 of the 74 surviving cases maintained the preoperative SR, whereas 13 developed AF, 10 were in JR, and 16 were in AVB. During the follow-up period (mean, 26 +/- 14 months), the majority of cases (47/74) regained SR; 11 patients had AVB, 3 were in JR, and the remaining 13 were in AF.

Conclusions: The use of the superior septal approach for mitral valve procedures in patients in preoperative SR is associated with minor, transient cardiac rhythm disturbances.